The Association of High Sensitivity C-reactive protein and Nitric Oxide with Elevated Blood Pressure during Dialysis in Intradialytic Hypertension

Abstract

BACKGROUND: Hemodialysis (HD) is a procedure to replace part of kidney function in patients with end-stage kidney disease. Hemodynamic disturbances during HD may include elevated blood pressure (BP). It is reported that about 5–15% of patients undergoing regular HD have increased BP during HD. This condition is called intradialytic hypertension (IDH). Increased high sensitivity C-reactive protein (hs-CRP) levels are associated with decreased endothelial dilatation response of blood vessels. Nitric Oxide (NO) is one of the mediators that act as a vasodilator to regulate vascular pressure. Endothelial dysfunction is one of the factors thought to contribute to the incidence of IDH. AIM: This study aimed to determine the association of hs-CRP and NO with elevated BP in IDH. METHODS: This observational cross-sectional study was conducted at Prof. Dr. R.D. Kandou General Hospital, Manado, from November 2021 to April 2022. Participants were selected through consecutive sampling methods. The levels of hs-CRP and NO were examined in all patients. The correlation between hs-CRP and NO was performed using the Spearman test, while the association of hs-CRP and NO with elevated BP was performed using the Fisher- exact test or Chi-square test. RESULTS: Forty patients were included in this study. The median hs-CRP, NO, and systolic BP (SBP) of the patients were 6.55 mg/dL (0.50–43.5),  27.77  mg/dL (3.65–72.19), and 20 mmHg (10–30), respectively. The correlation analysis showed that there was a strong significant negative correlation between hs-CRP levels and NO (r = −0.680, p = 0.000). Based on the Chi-Square or Fisher Exact test, there was a significant association between hs-CRP levels and elevated SBP (OR = 5.06; 95% CI = 1.095–23.44; p = 0.040), as well as between NO levels and elevated SBP (OR = 17.14; 95% CI = 3.063–95.938; p = 0.000). CONCLUSION: There was a significant association between hs-CRP and NO levels with elevated SBP in end-stage renal disease (ESRD) patients with IDH. ESRD on hemodialysis (ESRD on R-HD) patients with hs-CRP ≤3 mg/dL or NO levels <25 mg/dL tends to have increased SBP ≥20 mmHg after HD compared to ESRD patients with low hs-CRP or high NO levels.